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Dr. Dorgan brought family therapy to the area

Dr. Patrick Dorgan signs books that will be part of the J. Patrick Dorgan Strategic Family Therapy Library of the Middle Peninsula-Northern Neck Community Services Board. Looking on are therapist Wanda Dungan and CSB director Chuck Walsh. (Photo by Tom Chillemi)

by Tom Chillemi

Many of those who were helped by psychologist Dr. Patrick Dorgan may not know how fortunate they were.

For more than 34 years Dr. Dorgan’s vocation and advocation has been “Strategic Family Therapy,” a type of counseling that was still emerging in 1977 when he came to work for the Middle Peninsula-Northern Neck Community Services Board (MP-NNCSB) in Saluda.

At the time, Dr. Dorgan held a doctorate in counseling. But his degree from Boston University had not prepared him for clients whose family situations were at the root of their problems, or made them worse.
Most of his training was to help people who are “young, attractive, verbal, intelligent and socially adept,” otherwise known as YAVIS. “Back then, I worked with college kids and people in private practice,” Dr. Dorgan explained.

When he began work at the MP-NNCSB, however, the type of clients he counseled changed dramatically. “I had people coming into my office who beat up their kids, the kids were being taken out of the home, there was sexual abuse, physical abuse, and parents with substance abuse problems and major depression. There were protracted divorces and the kids were in the middle of this.”

Area CSB serves 5,500 people annually

Established by state law on February 28, 1974, the Middle Peninsula-Northern Neck Community Services Board (MP-NNCSB) serves individuals and families that have problems associated with mental health, substance abuse, intellectual disabilities, and developmental disabilities and delays experienced by infants and toddlers.

With an annual budget of $25 million, the agency receives $3.2 million in funding from the state, about $800,000 from the federal government and a combined $432,000 from the 10 counties the agency serves. The rest of its funding comes through Medicaid, and other third-party insurance reimbursements, explained executive director Chuck Walsh.

Its area of service stretches from Colonial Beach to Gloucester Point and includes the counties of Essex, Gloucester, King and Queen, King William, Lancaster, Mathews, Middlesex, Northumberland, Richmond and Westmoreland.

Of Virginia’s 40 community services boards, the MP-NNCSB serves the second largest area geographically, and the most number of localities. It is 18th largest in terms of budget and population served.

Of the 5,500 people served annually by the MP-NNCSB, 43% are on Medicaid, and another 4% have insurance. The rest of the clients (53%) pay on a sliding fee scale as they are able. “We subsidize the rest, which comes to about $1.2 million annually,” said Walsh.

With a staff of 500, MP-NNCSB said any employee pay raises must be earned and sustained, and a revenue source must be found to support raises. “In that respect we operate like any other business,” said Walsh.

Walsh added, “It’s a struggle to continue to do that every year especially when funding for services is being cut or other unfunded mandates are being placed on the boards or the localities.”

Walsh, originally from Philadelphia, Pa., started with the MP-NNCSB as a case manager in 1983 and was made executive director in 2003.

Using traditional methods such as having clients talk about their past and their childhood to figure out issues didn’t work. “I had no map,” said Dr. Dorgan. “I didn’t know what to do. These people wouldn’t come back to counseling without a court order.”

At the age of 30, Dr. Dorgan connected with Strategic Family Therapy founder Jay Haley. Haley had recently left the Philadelphia Child Guidance Clinic where he teamed with renowned psychiatrist and the author of “Families of the Slums,” Salvador Minuchin, to develop the Family Therapy Institute in Washington, D.C. Having attended several workshops led by Minuchin and Haley on how to treat difficult families, Dorgan embraced this model and sought funding to attend the institute and hone his craft under Haley’s tutelage.

It wasn’t an easy undertaking. Dorgan worked the required 40 hours at the community services board; and then late in the evening on most Thursdays either by bus or in a vehicle he would head to Washington, D.C. There he would stay with friends and begin to learn under Haley. This grueling schedule went on for about a year.

Dr. Dorgan sought the tough challenges. “I told Jay (Haley) that I wanted to see the most difficult cases you have. I want to see families where there is violence, sexual abuse and substance abuse because these are the cases that I’m seeing in my work now and I need to know how to help them.”

Dr. Dorgan could have gone into private practice or been a college professor, but instead he decided to stay at the MP-NNCSB because he wanted to help people.

A new way

MP-NNCSB executive director Chuck Walsh explained that Dr. Dorgan was instrumental in bringing competent “solution-focused” therapy services to an area that basically had none.

Previously, treatment often consisted of medicating an individual or, if that didn’t work, hospitalizing them. If the behavior continued, the next step was, unfortunately, putting them in jail.

Until strategic family therapy, therapy often dealt with “first order change,” said Walsh. “In other words, just moving the problem to another individual in the family constellation.”

Dr. Dorgan’s therapeutic interventions focused on “second order change,” said Walsh. “That is change that is so profound that the family cannot go back to their previous behavior. For Dr. Dorgan, it was essential to stop the problem from perpetuating and moving from one generation to the next. Dorgan’s focus was on stopping problems now.”

And stop it he did.

Countless lives have been changed and future generations spared from dealing with the same problems over again—all because back in 1977 Dr. Dorgan made a decision that changed forever how local individuals and families were helped.

Helping hundreds

It’s hard to say how many individuals and families Dr. Dorgan has helped over his 34-year career with the MP-NNCSB, but all one has to do is ask some of his staff members who attended his retirement reception on January 27. An audience of well-wishers and admirers was filled with young, seasoned therapists who learned from Dr. Dorgan.

Emily Eanes, a current therapist with the MP-NNCSB, and longtime student of Dr. Dorgan, spoke on behalf of many of the therapists when she said reverently, “Your work will continue and your mark will always be recognized because of the things you taught us.”

The recurring theme of all those who spoke and the words that were read from letters that many of his colleagues from various parts of the country wrote, talked about Dr. Dorgan’s “passion, commitment and dedication” to his work and the families that he helped.

“Dr. Dorgan never shied away from the proverbial hot potato case,” said Walsh in his retirement remarks. “Dr. Dorgan would always take the case that nobody else wanted. In all the years that I had the good fortune to work with him and learn from him, he never said no. He always did the right thing.”

A new way

Doing the right thing came easy for Dr. Dorgan, who used the invaluable insight he gained from Haley and the institute to transform the lives of clients of the MP-NNCSB.

Dr. Dorgan reminisced about the time when most Friday mornings at the clinic were devoted to teaching young therapists how to do Strategic Family Therapy. “Just about every Friday morning we would present a live case in front of the one-way mirror and a team of therapists would be behind the mirror observing as I would supervise the case in the same way that Haley did with me. Each therapist would present a case on a different Friday, and then the case would be debriefed. It was an incredible learning environment.”

These were powerful sessions, not just in helping families, but in training therapists who participated. Dr. Dorgan continues to do that same kind of teaching with his young therapists today at the Youth and Family Therapy Center in Saluda, although it continues to get more difficult.

“The times have certainly changed our profession,” said Dorgan. “Managed care, insurance companies and the need to generate revenue have created challenges to being able to do the kind of therapy and teaching we once did.”

Dr. Dorgan explained that from a business perspective it’s hard to justify a morning dedicated to working with one case with three or four therapists observing. “But that’s where you realize the most effective outcomes,” he said. “If you create that kind of learning culture, in the long run you actually save money.”

Part of Dr. Dorgan’s legacy will be how he changed counseling at a time when there was limited services available for those who were most in need. He brought to the Middle Peninsula and Northern Neck a strategy that encompasses the whole family and, in doing so, transformed the lives of hundreds if not thousands of people.

The MP-NNCSB board of directors has honored Dr. Dorgan with a resolution commending him for his “passion and commitment” to the organization and the community.

The board also dedicated the J. Patrick Dorgan Strategic Family Therapy Library in his honor, and named the current and any future Youth and Family Therapy office buildings be named the J. Patrick Dorgan Family Therapy Center.